Since 2019, 50 municipalities and three states have declared racism as a public health crisis. The declarations are meaningful, but how do they lead to real organizational change?


Despite the already huge and growing body of research indicating that past and current elements of structural racism are the leading cause of inequitable health outcomes between minority groups and their white counterparts in the US, addressing racism as a public health crisis has remained a contentious issue. But for those entities pushing past that tired debate and into the realm of action, what should a public health framework look at when assessing the barriers causing inequities for Black, Indigenous, and people of color (BIPOC), and how should strategies be implemented to achieve identified goals? Hint: the answer is tied to a wonky term dubbed by public health researchers and professionals as the social determinants of health (SDOH).

In layman’s terms, an organization or community’s SDOH are systemic drivers behind serious health issues for its BIPOC residents—the cumulative and compounding effects of an array of societal factors, including the history, culture, ideology, and interactions of institutions and policies that systematically privilege white people and disadvantage people of color.. These drivers result in disparate outcomes, such as the increased risk of diabetes, stress, maternal mortality, hypertension, asthma, etc.. Simply put, the SDOH are the factors linked to where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. 

Typically, these upstream factors are categorized in five domains, and this is where organizations should leverage their change initiatives:

  1. Economic Stability: How do we help people earn steady incomes that allow them to meet their health needs? 
  2. Education Access and Quality: How can we increase educational opportunities and help children and adolescents do well in school?
  3. Health Care Access and Quality: How do we increase access to comprehensive, high-quality health care services?
  4. Neighborhood and Built Environment: How can we create neighborhoods and environments that promote health and safety?
  5. Social and Community Context: How do we improve the community-based systems of support that improve health outcomes?

Separating an organization’s SDOH by domains helps us identify and prioritize the factors leading to inequities for BIPOC individuals. It helps large public sector organizations be strategic and focused, while also providing shared language to communicate to constituents. However, these domains are just a starting point. The next step is to unpack the specific barriers to equity BIPOC experience within these domains, and then identify the policies, practices, and systems that are involved in maintaining those barriers. Only then can we deconstruct them. 

As more jurisdictions declare racism as a public health crisis, we hope that they use the SDOH framework as a starting point for strategic planning and implementation as a way to address systemic barriers causing inequities for BIPOC stakeholders.